RFI Browser

RFI # 684:
Rendering Provider ID

Informal
Formal

Submitter

Robert Isman

Description

Non-independent dental hygienists in CA can provide preventive services (e.g., fluoride applications, dental sealants) under the general supervision of a dentist. CA Medicaid has never required a Rendering Provider ID for claim service lines involving these procedures in the past, and doesn't think they need to now under HIPAA. If the supervising dentist is different than the Billing Provider, is that supervising dentist's Rendering Provider ID required for such claims? Can you direct me to any source that says unequivocally that the Rendering Provider ID IS required for such claim service lines?

Submitter Assigned Keywords

Rendering Provider Dental Hygienist

Response

This issue is explicitly addressed in guide 004010X097A1. Loop 2310B (Rendering Provider) NM1 segment note three states "Required when the Rendering Provider NM1 information is different than that carried in either the Billing Provider NM1 or the Pay-to Provider NM1 in the 2010AA/AB loops." Therefore, for electronic dental claims where the rendering provider information is different than the billing or Pay-to provider information, identification of the rendering provider in the 2310B loop is required. When the billing/pay-to provider is a non-person entity, a rendering provider must be supplied. There is no statement as to whether this must be the related hygienists or the supervising dentist.